The Role of Schools in Accessing Mental Health Services for Children Exposed to Domestic Violence

BACKGROUND/PURPOSE:

This qualitative study’s findings illuminate the role schools play in access to mental health (MH) care for children exposed to adult domestic violence (DV), who are at risk for psychological problems, including externalizing and internalizing disorders (Wolfe et al.,2003), and post-traumatic stress (Chemtob & Carlson,2004). These children represent a vast, often invisible population, with an estimated 18.8 million children exposed to DV prior to age 17 (Hamby et al.,2011). Because of the amount of time children spend in school each day, schools are positioned to act as MH service providers or as gateways to providers (American Academy of Pediatrics,2004; Gamble & Lambros,2014). However, MH concerns are often seen as secondary to education, both by school personnel (Nastasi, Overstreet, & Summerville,2011) and parents (Langley et al.,2013). 

METHODS:

Using purposive and maximum variation sampling, an ethnically/racially diverse sample of mothers (N=30) of children currently enrolled in school was recruited from five shelters. Interviews focused on their experiences seeking help to address emotional/behavioral needs of one “focus child,” whom the mother identified as her child with the greatest challenges. Focus children were ages 5-17 (mean=9.6); half were male. Qualitative data were supplemented by: Abusive Behavior Inventory (Shepard & Campbell,1992); Parent Report of Post-traumatic Symptoms (Greenwald & Rubin,1999); Strengths and Difficulties Questionnaire (Goodman,2001). Two independent coders reviewed verbatim transcripts of each interview, coding for thematic and categorical content relating to family help-seeking experiences for child emotional/behavioral concerns, including through the child’s school, followed by a consensus discussion on final codes. Analysis continued in an iterative process, including individual case summaries and diagrams mapping family experiences.

RESULTS:

Most focus children (n=21,70%) had one or more indicators of poor MH. Few had ever received sustained, effective MH care. Mothers described numerous barriers, especially DV dynamics, to obtaining help for child MH. In eight cases mothers turned to the school for help, in eight other cases schools initiated conversation about child MH with mothers, and one child initiated MH assistance from school. Behavioral issues most often triggered school and maternal concerns, with the school only concerned about emotional issues like depression when they impacted learning.

Family-school transactions emerged as turning points shaping subsequent help-attainment trajectories. Mothers encountering barriers in school interactions tended to reduce further efforts, while facilitative school interactions often increased subsequent help-seeking. Barriers experienced most often involved schools’ lack of follow-through; school personnel humiliating family members; personnel minimizing problems (especially non-behavioral); and high family mobility interrupting school relationships/services. Facilitative influences experienced most often were special education services/testing, school-based counseling, supportive family-teacher relationships, and referrals to outside providers.

IMPLICATIONS:

Schools might facilitate MH service access for children exposed to DV with staff training and oversight focused on: DV dynamics (including isolation and shame), internalizing disorders, professionalism (e.g., supportive parent relationships, follow-through, non-shaming communication with DV victims), and widespread education/referral on community MH services (to counteract mobility-related challenges). Future research should address these practice areas, and examine more closely families of children with MH concerns where neither parent nor school initiates services.